Comments on: Embracing the idea of addiction management

By: Haley Weiner

Haley Weiner — Fri, 11 Dec 2009 19:05:39 +0000

Shannon’s post rings true because it addresses the fact that we as humans often and in many ways do not care for each other, and at times it feels like participation in this culture is hinged upon adopting uncaring attitudes towards people. For instance, how often do we “tune out” homeless people on the street, because there are so many of them and we can’t give them all money, so we might as well pretend we are blind to their issues, and their very existence. The sad part to me is, given this world we’re in, many of us find addiction to be an adaptive way of participating in the culture. It is possible to be successful with an addiction, in fact, I’d say sometimes addictive behaviors, such as womanizing, can help facilitate the versions of extreme power we see played out by “Great Men” who rule the world, who embody what seems to be a destructive power.

By: luis g

luis g — Sun, 06 Dec 2009 22:58:49 +0000

Response to “jryan says: October 26, 2009 at 10:36 am”

Your idea of adding social skills type classes into our school system is great, great and superb! Merely training students academically is setting them up for failure. Knowing how to read the periodic table of elements will avail you nothing when you get laid off the job and someone offers to get you high to take your mind off of it. This is program that would surely be beset by attackers on all side if introduced at the next PTA meeting. “Teach my kid about crack, prostitutes and finances?! Its my kid. I’ll tell them about them when it right and proper!” is something along the lines this program would be met with. But with time and patience it can see the light of day. Training our children to not only become a great student, to nurture their emotional I.Q and skills to be a better citizen in our society will only help us all in the long run.

By: Nicolea

Nicolea — Tue, 01 Dec 2009 23:40:56 +0000

No problem this big gets solved one clinician at a time. There are too many variables, too many invested parties and too much red tape. Our profession has recently just won the right to bill insurance in all 50 states…this took time. It also took a large population of professionals to join together, write letters, donate money and time to ensure that, through the legislative process, counselors received the same benefits as MSW’s. The NAADAC’s website states it supports a comprehensive approach, yet still identifies specific substance abuse without addressing overall addictive behaviors. NAADAC’s legislative committee even asks for funding that only addresses substance abuse without taking a holistic account of the disease.

$1.847 billion – Substance Abuse Prevention & Treatment Block Grant
$472 million – Center for Substance Abuse Treatment (CSAT)
$210 million – Center for Substance Abuse Prevention (CSAP)
$1.064 billion – National Institute on Drug Abuse (NIDA)
$464 million – National Institute on Alcohol Abuse and Alcoholism (NIAAA)
$441 million – Safe & Drug Free Schools/Communities

Based on this information I must assume that our society and addiction professionals are not ready for a holistic approach of addiction management. Addiction is the number one public health issue in the United States today. According to the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 22.2 million people aged 12 or older needed treatment for an alcohol or illicit drug problem in 2003. Of those 22.2 million people – almost 10% of the US population – only 1.2 million received treatment for their disorder. Unfortunately, for our society the addiction problem may only get worse. Until we truly all get on the same page our fate looks bleak.

By: AnneW

AnneW — Wed, 18 Nov 2009 06:19:36 +0000

I agree with Sara G that many of the problems associated with access to addiction treatment stem from a lack of access to health care in general, especially for those at a lower income. Unfortunately, it is these same folks that addiction so often afflicts and therefore a greater percentage of addicts cannot afford quality addiction treatment. This automatic barrier certainly impacts the 90% of folks that never receive treatment. In an effort to preserve the welfare of our country, it seems logical that our government’s top priority be to provide health care for of ALL of its citizens, not just those privileged few who can afford it. Additionally, as addiction has been noted as the nation’s #1 health care problem, the treatment of addiction should in turn be viewed as our government’s chief health care concern. Once universal health care, specifically for addiction treatment is seen as worth investing in, we can begin to look at how we can further prevent and manage its treatment.

I believe that for health care professionals to perceive addictions as a chronic disease requiring long-term medical attention, it would require a sea change in the way our nation views and responds to individuals with addictions. I agree with sthorpe that raising the societal and individual standards for both mental and physical health is key to increasing access to treatment for individuals suffering from addictions. Evidence shows that an individual’s level of self-efficacy and sense of belonging in the world play a major role in their interest in and motivation for seeking help as well as in producing more positive treatment outcomes. Perhaps if the stigma associated with addictions was lifted, we would be able to deal more effectively with the serious health issues associated with the disease. How do we do this? Could it start with grassroots efforts to create awareness around addiction and the complicated physiological, psychological, and social factors associated? When I look at HIV/AIDS, another incurable chronic disease with a similarly hefty stigma, I can see the progress made with just this type of grassroots movement.

Similar to how addictions are currently perceived, HIV/AIDS was once viewed as a disease of degenerates, only afflicting the weak and morally reprehensible. Although this stigma still exists, much progress has been made and today HIV/AIDS is viewed in a much more tolerant and compassionate light. Currently, most health care facilities view HIV/AIDS as a worthwhile health care challenge and major medical breakthroughs have been made in the management of the disease. Much of this change has to do with education and grassroots organizing to raise funds for treating and awareness about the disease. Considering that most, if not all, of us have been touched in some way by addictions couldn’t we work in solidarity to create a positive “addictions culture” whose mission is to raise consciousness about and provide support for victims of addiction. I long to see addictions walks, bake sales, and auctions all to support people with addictions. Perhaps then we could help reduce the terrible stigma and resulting shame associated with the illness and the real healing could begin.

By: R.J.

R.J. — Sat, 14 Nov 2009 00:55:58 +0000

It has been mentioned in many of the previous posts…the issue of funding. There is a surprising lack of funds available for those who need treatment but who cannot pay for treatment and in this economy those who can afford treatment are dwindling by the day. The cost of treatment is a clear roadblock to moving towards a chronic care system of treatment.

Cost of treatment, who will pay, for how long, and for what is a consistent concern of those accessing treatment. Though our jails, courthouses, and budgets are crowded by those who have committed crimes associated with alcohol, drugs, gambling, and other excessive behaviors, our government spends a pittance on prevention services for and the funding of treatment for those in need. Our private insurance system that generates billions of dollars does it’s very best to ensure that they are able to excuse themselves from paying for treatment. Most who don’t have private health care can’t access public care because, you guessed it, there’s a lack of public funding.

The very fact that there is a blog like this and that current research is beginning to lean towards a chronic care model is indeed a good sign. We have to remember that counseling, therapy, and the treatment of addiction is a relatively new field of study and profession. As technology, research, and acceptance of addiction treatment progresses, there is hope that our society will begin to put a premium on the prevention and treatment of a truly chronic disease. The problem is that it will take MORE time and a LOT more money!

By: Meghan Greider

Meghan Greider — Thu, 12 Nov 2009 00:54:31 +0000

As many people have already said, education is a huge aspect of viewing addiction as a chronic problem. I admit that before starting this class I was not aware of all of the aspects of addiction and primarily perceived it as an acute problem that lies within the individual. However, we have to move away from this view (all of society, not just health care providers) in order to change how addiction is treated. I believe that addiction is stigmatized in the same way that HIV/AIDS was (and still is) and many people see the illness as the person’s fault. Yes, maybe some responsibility lies in the individual but does that mean he or she does not deserve to get the best care possible? Perhaps if addiction is better understood then shifting treatment focus to long term care rather than a short fix will be more plausible

By: MRW

MRW — Sun, 08 Nov 2009 17:20:51 +0000

I think one thing we all agree on first is that the perception of addictions being “their choice,” needs to change before treatment will actually be effective. In line with that the current system of treating it as an acute problem. I think our treatment system, detox, self-help groups, residential care, CBT, are “good” at least overall, but it’s the foundation of each that need to change and that is where we need to start looking at this as a chronic condition and not a “that’s their choice/problem,” way. I think about detox, you go in for a few weeks, get meds, detox…and then you’re out of there? This just isn’t effective…so I think we do have “good” treatment BUT in each method need to redesign it so that it is effective.

By: Azusa

Azusa — Thu, 05 Nov 2009 06:45:37 +0000

One of the positive trends that is helping increase acceptance of a medical approach to addiction is the growing awareness that addiction is not a moral failure, but rather a chronic medical disease with similarities to other chronic medical diseases such as diabetes, hypertension, and asthma. However, as Dr. Fitzgerald pointed out in the blog, it is so true that yet, addiction is typically, largely treated as if it is an acute condition, altering perceptions to think of addiction as a chronic illness may change the way it is treated and insured.
I propose that altering individuals’ perception and exploring their awareness toward addiction is a starting point for care, and once they are treated, chronic substance use disorder management should involve longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based treatment; and availability.
Addiction treatment should also be held to the same standards used to judge treatment of other chronic diseases, where relapse and noncompliance with therapy and medication are common. Management of addiction should also include long-term care requiring patient progress be measured in predefined steps, and that relapse result in an intermediate step back, not removal from the program. Frequent contact by phone, or e-mails from care providers would be beneficial from both an outcomes and cost perspective, because this way clients can be kept at the low end of the continuum of care, not where it’s expensive.
I also believe incorporating mental health and specialty addiction care, definitely holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care.

By: admin

admin — Wed, 04 Nov 2009 23:28:09 +0000

Aaron, appreciate the feedback. Great thing about a blog is that it allows for multiple opinions that I believe moves the entire field forward. I also would echo your suggestion that attending 12 step or other self-help meetings can be a wise place to start if you need immediate help staying sober, and treatment is great if you can get it. For those who cannot access treatment or cannot find a good fit with a self-help group I would also say all is not lost. We know there are many paths to moving ones life in a healing direction.

By: Aaron Wintergreen

Aaron Wintergreen — Wed, 04 Nov 2009 23:03:22 +0000

A center for addiction treatment is more than likely the best place to start if you’re in dire need of sobriety. Your blog brings up some interesting points. I’m not sure if I agree entirely, but new ideas are important.

If you are having problems staying sober, I’d suggest attending a few 12 step meetings or entering directly into rehab.